PPD: A problem after child birth | By Nighat I Durrani


PPD: A problem after child birth 

POST-Partum Depression (PPD) is a complex disorder of hormonal, emo tional and behavioural changes, happening within 4 weeks or soon after child birth. PPD is linked to social and psychological factors experienced by recently delivering mothers. It can be treated through counselling by senior mothers, gynaecologists, or a senior midwife. The question arises, how this happens especially in the lactating mothers. In fact, the body experiences chemical changes of rapid drop in reproductive hormones- oestrogen and progesterone, increased tenfold during pregnancy and getting dropped sharply after delivery and start rising within a week after delivery to the level of prior to pregnancy.

The history of depression, prior to pregnancy is important, (the younger the patient, the higher the incidence of PPD); even apprehension of future pregnancies may result in PPD. Family history of psychological disorder, or any sudden stress-full event like loss of job or any health problems of the newborn, past history of premenstrual tension, limited social and economic support, living alone without any family care, a marital conflict, drop of thyroid hormones overwhelmed by tiredness and lack of sleep. Other factors are related to the mother’s personal and physical health, or you may be over-anxious about your ability to care for the newborn; all these factors can contribute to the incidence of PPD.

In fact, these depressive changes happen in 10 mothers or rarely 1 in 1,000 with serious symptoms of psychosis. These symptoms are based on financial, family and psychological reactions after the arrival of a new baby. Usual symptoms are loss of proper sleep, appetite, severe fatigue, and frequent temperamental changes like crying without any reason, they even refuse to nurse the baby, detesting further pregnancies. At times, they may exhibit severe anger, lack of normal interest in the family affairs, expressing helplessness and obsessive-compulsive disorder (OCD). These obsessions are unfounded fears that may result, sometimes, in panicky situations. Untreated postpartum depression can be dangerous for the baby, mother herself and even other family members. These symptoms may persist beyond 2 weeks and different in different mothers.

PPD can happen in a few days or even months after childbirth, not just after the first child affecting the ability to perform normal routine functions of a household. PPD may become a very serious mental illness for the new mothers within the first 3 months after childbirth. She may have auditory hallucinations (apprehension of hearing strange voices), or delusions (irrational things), and visual hallucinations (things that aren’t there). Other symptoms include insomnia (sleep less-ness), feeling agitated and angry. If symptoms persist, mothers are even admitted in the hospital because they are at risk for hurting themselves or someone else. At this stage, she must seek professional advice. She will be given a treatment plan, otherwise symptoms can worsen, assuring that such mothers will get normal after medication and counselling.

Treatment includes anti-anxiety or anti-depressant medication, psychotherapy, and emotional support from the family, usually under a professional guidance. However, there is no harm if the nursing mother takes medication while breastfeeding. If not treated in time, it can weaken the family bond, the baby and the other family members. Even, it can last for a longer period, turning to chronic depressive state in future life. The babies may develop problems with normal sleeping patterns, their feeds, crying more than usual and delayed in speaking progress.

The mothers can manage mild symptoms through counselling, if it persists, an early check-up is necessary and they soon get well. However, a word of advice to mothers to keep active, take a walk, and get out of the house for a break. Use a nutritious diet, avoid too much tea or coffee, improve the relationship with the kith and kin, keeping herself busy and avoid isolation, limit your phone calls and sleep when your baby is sleeping. These simple and well-in-time measures will help the mothers to overcome the sickening problem of PPD.

—The author is a former Registrar of Pakistan Nursing Council Islamabad and a Senior Nursing Teacher & examiner of Nursing Profession.
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